Kentucky - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Kentucky, Respite Care Services provide essential short-term relief to unpaid primary caregivers of Medicaid members enrolled in Home and Community Based Services (HCBS) waivers. Because Kentucky does not issue a standalone 'Respite Care' license, agencies must first obtain licensure as a Personal Services Agency (PSA) for in-home care or an Adult Day Health Care (ADHC) center for facility-based care before they can enroll to provide waiver respite services.

The single biggest structural barrier to entry for new respite providers in Kentucky is the mandatory two-step enrollment and managed care contracting process. After obtaining state licensure and enrolling through the Kentucky Medicaid Partner Portal Application (KY MPPA), providers must separately credential and contract with up to five regional Managed Care Organizations (MCOs). These MCOs enforce network adequacy standards and can impose closed networks, meaning they may refuse to contract with new respite providers if they determine their region already has sufficient coverage, effectively blocking the provider from billing for most waiver participants.

1. Service Definition and Scope

Respite care in Kentucky is defined as short-term, temporary care provided to a waiver participant to relieve the unpaid primary caregiver of their daily support duties. This service ensures the participant continues to receive necessary supervision, personal care, and health monitoring while the primary caregiver steps away for rest, errands, or emergencies.

Services are authorized under Kentucky's primary HCBS waivers, including the Home and Community Based (HCB) Waiver, the Michelle P. Waiver (MPW), and the Supports for Community Living (SCL) Waiver. Respite cannot be used as a substitute for regular childcare or adult daycare while the caregiver is at work, nor can it replace full-time residential care.

• Service Settings: Can be delivered in the participant's home, the licensed provider's home, or a licensed facility such as an Adult Day Health Center.
• Waiver Programs: Funded primarily through the HCB, MPW, and SCL Medicaid waivers.
• Prohibited Uses: Cannot be billed for time the primary caregiver is at their place of employment.
• Duration Limits: Total allowable respite hours are strictly capped by the participant's annual Person-Centered Service Plan (PCSP) budget.
• Reimbursement Structure: Billed in 15-minute increments for short durations or as a per diem rate for overnight or extended stays.
• Caregiver Coordination: Requires documented coordination with the primary caregiver and the waiver case manager to ensure continuity of care.

2. Regulatory and Oversight Agencies

The Kentucky Cabinet for Health and Family Services (CHFS) is the umbrella organization overseeing all Medicaid and facility licensing in the state. Within CHFS, distinct departments handle the various phases of provider approval, from physical site licensing to Medicaid enrollment and waiver administration.

Providers must interact with multiple state portals and divisions, as well as the Managed Care Organizations (MCOs) that ultimately authorize care and process claims for the majority of Kentucky's Medicaid population.

• Cabinet for Health and Family Services (CHFS): The primary state health authority overseeing all Medicaid and licensing functions (https://chfs.ky.gov).
• Office of Inspector General (OIG): The CHFS division responsible for inspecting and licensing health facilities, including Personal Services Agencies and Adult Day Health Centers (https://chfs.ky.gov/agencies/os/oig).
• Department for Medicaid Services (DMS): Administers the HCBS waivers, sets fee schedules, and oversees provider enrollment (https://chfs.ky.gov/agencies/dms).
• Department for Aging and Independent Living (DAIL): Establishes operational standards for adult day health programs and aging services (https://chfs.ky.gov/agencies/dail).
• Kentucky Medicaid Partner Portal Application (KY MPPA): The mandatory online system for submitting state Medicaid enrollment applications (https://medicaidsystems.ky.gov/Partnerportal/home.aspx).
• Managed Care Organizations (MCOs): Entities like WellCare, Anthem, and Humana that credential providers, authorize PCSP services, and pay claims (e.g., https://www.wellcare.com/Kentucky/Providers).

3. Gatekeeping Prerequisites: Who Can Even Apply

Before applying for licensure or Medicaid enrollment, prospective respite providers in Kentucky must navigate specific structural preconditions. While Kentucky does not require a Certificate of Need (CON) for non-medical Personal Services Agencies providing basic in-home respite, a CON is strictly required if the entity intends to operate as a Home Health Agency.

The most significant gatekeeping prerequisite is MCO network adequacy. Because Kentucky delivers most Medicaid waiver services through managed care, obtaining a state license and Medicaid ID does not guarantee the ability to serve clients. MCOs utilize closed networks and may refuse to issue contracts to new providers if they determine the geographic area is already adequately served.

• Certificate of Need (CON): Not required for Personal Services Agencies (PSA) or Adult Day Health Centers; strictly required under KRS 216B if applying as a Home Health Agency.
• MCO Network Adequacy (Closed Networks): MCOs may close their provider networks to new applicants based on regional supply, blocking access to waiver participants even if state enrollment is approved.
• Business Registration: Applicants must be registered and in good standing with the Kentucky Secretary of State prior to submitting any licensing applications.
• NPI Requirement: The agency must obtain a Type 2 National Provider Identifier (NPI) from the federal NPPES registry.
• Physical Location: Providers must maintain a physical commercial office space in Kentucky or a designated border county; virtual offices or P.O. boxes are prohibited for licensure.
• Tax Identification: Must possess an active IRS Employer Identification Number (EIN) matching the business registration.

4. Licensure and Certification Requirements

Kentucky does not issue a specific 'Respite Care License.' Instead, providers must obtain the license that corresponds to their service delivery model. For in-home respite care, agencies must be licensed by the OIG as a Personal Services Agency (PSA). For facility-based daytime respite, providers must be licensed as an Adult Day Health Care (ADHC) program.

The licensure process involves submitting a detailed application, paying the required fees, and passing an initial on-site survey by the OIG to verify that the physical office and administrative policies meet state regulatory standards.

• In-Home Licensure: Must obtain a Personal Services Agency (PSA) license governed by 902 KAR 20:360.
• Facility Licensure: Must obtain an Adult Day Health Care (ADHC) license governed by 902 KAR 20:066 if providing facility-based daytime respite.
• Application Form: Providers must submit form OIG-144 (Application for License to Operate a Health Facility or Service) to the CHFS Office of Inspector General.
• Licensure Fee: Requires an initial and annual renewal fee (e.g., PSA fees are typically set by OIG schedule, subject to legislative updates).
• On-Site Survey: The OIG conducts a mandatory initial inspection of the agency's physical office, personnel files, and policy manuals before issuing the license.
• Insurance Requirements: Must maintain general liability insurance and, if operating a facility, property and workers' compensation insurance.

5. Medicaid Provider Enrollment

Once the appropriate OIG license is secured, the agency must enroll as a Kentucky Medicaid provider. This is done exclusively through the Kentucky Medicaid Partner Portal Application (KY MPPA). This step generates the state Medicaid Provider ID, which is a strict prerequisite for the subsequent MCO credentialing phase.

Enrollment requires comprehensive disclosure of ownership, background screenings for key personnel, and payment of federal application fees. Providers must select the specific waiver provider types (e.g., Provider Type 32 for Waiver Services) that align with their OIG license.

• Enrollment Portal: All applications must be submitted through the KY MPPA (https://medicaidsystems.ky.gov/Partnerportal/home.aspx).
• Provider Type Selection: Must enroll under the specific HCBS waiver provider types applicable to HCB, MPW, or SCL programs.
• Application Fee: Must pay the CMS-mandated Medicaid institutional application fee (approximately $731 for 2024/2025) unless proof of Medicare enrollment fee waiver is provided.
• Ownership Disclosure: Must disclose all individuals or entities with a 5% or greater direct or indirect ownership interest in the agency.
• State Background Checks: Owners and managing employees must undergo fingerprint-based criminal background checks as part of the state enrollment process.
• MCO Credentialing: After receiving the state Medicaid ID, providers must submit separate credentialing applications to each MCO (Aetna, Anthem, Humana, Passport, WellCare) operating in their target counties.

6. Staffing, Training and Background Checks

Direct care staff providing respite services must meet stringent qualifications designed to protect vulnerable waiver participants. These standards are enforced by both OIG licensure rules and DMS waiver regulations, requiring thorough background screening before any client contact occurs.

Agencies are responsible for maintaining up-to-date personnel files that prove compliance with age, education, health, and training mandates. Failure to maintain these records is a leading cause of survey deficiencies.

• Age and Education: Direct care staff must be at least 18 years of age and possess a high school diploma, GED, or equivalent work experience.
• Criminal Background Checks: Mandatory screening through the Kentucky Applicant Registry and Employment Screening (KARES) system prior to employment.
• Registry Clearances: Must verify staff are not listed on the Kentucky Child Abuse and Neglect (CAN) registry or the Caregiver Misconduct Registry.
• Health Screening: Staff must provide proof of a negative TB skin test or chest x-ray before initiating direct participant care.
• Basic Training: Must hold current, valid certification in CPR and First Aid from a recognized training organization.
• Participant-Specific Training: Staff must be trained on the specific needs, behaviors, and emergency protocols outlined in the individual participant's Person-Centered Service Plan (PCSP).

7. Documentation, Policies and Records

Respite providers must develop and strictly adhere to a comprehensive Policy and Procedure Manual. This manual must cover participant rights, grievance processes, emergency operations, and HIPAA compliance, serving as the operational blueprint during OIG audits.

Clinical and service documentation must be meticulously maintained. Every respite shift must be recorded with exact start and stop times, the specific activities performed, and the signatures of both the staff member and the participant or primary caregiver.

• Policy Manual: Must maintain a comprehensive manual detailing participant rights, intake procedures, and emergency backup plans.
• Service Logs: Each visit must be documented with date, exact start/stop times, location of service, and a description of the relief provided.
• PCSP Alignment: All provided services must directly align with the authorized hours and goals specified in the participant's active Person-Centered Service Plan.
• Incident Reporting: Critical incidents (e.g., falls, suspected abuse, medication errors) must be reported to CHFS and the participant's MCO within 24 hours.
• Record Retention: All clinical, personnel, and billing records must be securely retained for a minimum of 6 years from the date of service.
• HIPAA Compliance: Must implement physical and electronic safeguards to protect Protected Health Information (PHI) across all documentation platforms.

8. Billing, Rates and Claims

In Kentucky, most HCBS waiver respite claims are billed directly to the participant's Managed Care Organization (MCO) rather than the state fee-for-service system. Providers must secure prior authorization from the MCO before delivering services, ensuring the requested hours do not exceed the participant's waiver budget.

Kentucky strictly enforces the 21st Century Cures Act mandate for Electronic Visit Verification (EVV) for in-home personal care and respite services. Providers must use an approved EVV system to capture the time, location, and personnel for every shift to avoid claim denials.

• Billing Codes: Services are typically billed using standard HCPCS codes such as S5150 (unskilled respite care, per 15 minutes) or S5151 (per diem).
• EVV Mandate: In-home respite requires strict EVV compliance; Kentucky utilizes Therap as the state aggregator, though MCOs may have specific EVV vendor requirements.
• Rate Setting: Maximum allowable reimbursement rates are established by the DMS HCBS fee schedule, though final contracted rates may vary slightly by MCO.
• Prior Authorization: Every unit of respite care must be prior-authorized by the MCO based on the case manager's approved PCSP.
• Claim Submission: Claims are submitted electronically via the respective MCO's designated clearinghouse (e.g., Availity).
• Timely Filing: Claims must be submitted within the timeframe dictated by the MCO contract, which is often 90 to 365 days from the date of service.

9. Approval Sequence and Timeline

Becoming a fully active, billing respite provider in Kentucky is a lengthy, sequential process. Because each step relies on the approval of the previous one, agencies cannot run applications concurrently.

From initial business formation to the final MCO contract execution, providers should anticipate a timeline of 6 to 9 months. Delays in OIG surveys or MCO credentialing committees can extend this timeline further.

• Step 1: Business Formation and NPI: Register with the Secretary of State and obtain an EIN and Type 2 NPI (1 to 3 weeks).
• Step 2: OIG Licensure: Submit the OIG-144 application, pay fees, and pass the initial on-site facility/agency survey (60 to 90 days).
• Step 3: KY MPPA Enrollment: Submit the state Medicaid enrollment application and clear background checks to receive a Medicaid ID (45 to 60 days).
• Step 4: MCO Credentialing: Apply to individual MCOs for network inclusion and complete the credentialing committee review (90 to 120 days per MCO).
• Step 5: Contracting and Onboarding: Execute MCO contracts, set up EVV systems, and begin receiving prior authorizations (2 to 4 weeks).
• Total Timeline: Expect a minimum of 6 to 9 months before the agency is fully authorized to bill for Medicaid waiver participants.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to administrative oversights, incomplete documentation, or failure to adhere to strict EVV protocols. The two-step enrollment process is particularly prone to errors if providers attempt to contact MCOs before their KY MPPA status is fully active.

During OIG surveys, the most common deficiencies relate to incomplete personnel files. Missing background checks or lapsed CPR certifications can result in immediate citations and delayed licensure.

• Application Denial: Failure to fully disclose ownership percentages or pay the required application fee in the KY MPPA portal.
• Survey Deficiencies: Missing TB test results, incomplete KARES background checks, or lapsed CPR/First Aid certifications in staff personnel files.
• EVV Claim Denials: Mismatches in EVV data, such as a caregiver clocking in from an unauthorized location or using manual time entry without a valid state-approved reason code.
• Authorization Denials: Billing for respite hours that exceed the annual limit authorized in the participant's PCSP or failing to secure prior authorization before the shift.
• Credentialing Rejections: Submitting MCO credentialing applications before the state KY MPPA enrollment is fully approved, or applying to an MCO with a closed network.
• Policy Failures: Lack of a documented emergency backup plan for when a scheduled respite worker fails to arrive.

11. Key Contacts and Resources

Navigating the Kentucky Medicaid landscape requires direct communication with several state divisions and managed care partners. Providers should rely on official state portals for the most current fee schedules, waiver manuals, and regulatory updates.

The KY MPPA contact center and the OIG regional offices are the primary lifelines for providers during the initial licensing and enrollment phases.

• KY MPPA Provider Contact Center: Technical support for state Medicaid enrollment at 1-877-838-5085 (https://medicaidsystems.ky.gov/Partnerportal/home.aspx).
• CHFS Office of Inspector General (OIG): For PSA and ADHC licensing applications and survey inquiries (https://chfs.ky.gov/agencies/os/oig).
• Department for Medicaid Services (DMS): For HCBS Waiver regulations, fee schedules, and policy manuals (https://chfs.ky.gov/agencies/dms).
• Therap (Kentucky EVV): Information and support for the state's Electronic Visit Verification aggregator (https://www.therapservices.net/kentucky).
• WellCare of Kentucky (MCO): Provider credentialing and network contracting (https://www.wellcare.com/Kentucky/Providers).
• Kentucky Secretary of State: For initial business registration and standing verification (https://www.sos.ky.gov).

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